[Acute Coronary Syndrome Registry of High Risk Patients: 30-Day Outcome].

AIM: The aim of the study is to evaluate important additional cardiovascular (CV) risk factors of major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS) during the first 30 days after index event. MATERIALS AND METHODS: Overall 750 patients with ACS were enrolled in the single center prospective registry from 2012-2015yy. 569 patients received dual antiplatelet therapy and in 425 cases platelet function testing (PFT) were performed. Most of the patients characterized as high risk elderly patients with multiple CV risk factors and high comorbidity index. RESULTS: At 30-day follow-up the mortality rate was 10,1%. Singlevariate analysis showed strong association between MACE and age, atrial fibrillation, stroke, chronic kidney disease, low ejection fraction, type 2 myocardial infarction (T2MI). Multivariate analysis showed that high-on-treatment platelet reactivity (PFT> 45%) with odds ratio 4.418 (p=0.0001), chronic kidney disease (OR 6.538 p=0.001) and T2MI (OR 1.925 p=0.0001) were significantly associated with adverse outcome. CONCLUSION: ACS registry showed high mortality level in real-life practice compared with randomized clinical trials due to the high prevalence of elderly patients with high comorbidity index. Patients with T2MI have significantly more severe prognosis and chronic kidney disease associated with increased MACE. PFT in this category of patients is reasonable for more accurate risk stratification.

[Relation of Functional Activity of Platelets to Prognosis of Unfavorable Cardiovascular Events in Patients with Acute Coronary Syndrome. Results of a Registry Study].

AIM: to assess relation ofhigh functional activity ofplatelets to prognosis ofunfavorable cardiovascular events in patients with Acute Coronary Syndrome (ACS). MATERIALS: The study was based on the data of a single center ACS registry conducted in the Central Clinical Hospital of the Presidential Affairs Department of Russian Federation. Of 529 included patients in 425 without contraindications to double antiplatelet therapy we carried out analysis of dependence of 30 days level of unfavorable events on parameters of functional activity of platelets. RESULTS: High on-treatment platelet reactivity (HTPR) was found to be associated with 3.5 increase of mortality in the group of patients with high cardiovascular risk. Logistic model of prognosis of unfavorable events based on multifactorial analysis of data from patients with measured platelet aggregation included chronic kidney disease, type of myocardial infarction, and degree ofplatelet aggregation >45%. C -statistic was equal to 0.77. We also present in this paper discussion of problems related to studying approaches to individualization of anti-aggregation therapy in real clinical practice and problems of organization ofsimilar studies. CONCLUSION: The study showed that patients with ACS increased platelet aggregation, as well as chronic kidney disease and type 2 MI are associated with a 30 day prognosis of adverse events.

[Duration of Dual Antiplatelet Therapy in Patients With Ischemic Heart Disease After Implantation of Endovascular Stents].

Optimal duration of dual antiplatelet therapy (DAPT) after stent implantation is uncertain. Some patients have an extended risk of thrombotic complications including that of very late stent thrombosis after cessation of recommended course of DAPT (6-12 months). On the other hand, there is a real risk of bleeding on DAPT. In this review, we present and discuss results of clinical trials of long-term DAPT and data of their meta-analyses. The review also contains consideration of some aspects of new AHA/ACC recommendations (2016) on duration of DAPT.

[A case of primary diagnosis of patent ductus arteriosus at the age of 75 years]. / Sluchai pervichnoi diagnostiki otkrytogo arterial'nogo protoka u patsientov v vozraste 75 let.

The paper describes a case of primary diagnosis of functioning patent ductus arteriosus in a 75-year-old female patient.

[Hypolipidemic and pleiotropic effects of a combination of simvastatin and ezetimibe in patients with different types of hyperlipidemia].

The review considers trials dealing with the efficiency of combination hypolipidemic therapy with simvastatin and ezetimibe. Its synergistic potentiating effect can cause a considerable decrease in the level of total cholesterol, low-density lipoproteins, triglycerides, and C-reactive protein, which are important participants in the atherogenic process. This effect promotes the achievement of hypolipidemic therapeutic goals in many cases when this cannot be attained by high-dose statin monotherapy. The authors consider the results of trials of combination hypolipidemic therapy with simvastatin and ezetimibe performed as basic ones done in both previous and recent years.

[Disturbances of primary hemostasis in patients with dilation cardiomyopathy].

We studied morphological characteristics of platelets and parameters of platelet aggregation in patients with dilation cardiomyopathy. Augmented aggregatory activity of platelets was found in 76% of patients. In blood of majority of patients we found circulating leukocyte-platelet aggregates. This evidenced for development of inflammatory process and could be related to disturbances of blood rheology. In 2 patients examined by virusological method we revealed presence of a virus inside platelets. This phenomenon might serve as one of possible pathological pathways of disease progression at the account of spread of viral infection along vascular bed during thrombus formation.

[Platelet activation and inflammation markers in patients with coronary heart disease and depression].

AIM: To study morphological features and functional activity of platelets, their relations with the level of inflammation markers in coronary heart disease (CHD) patients with depression. MATERIAL AND METHODS: The study group consisted of 33 CHD patients with stable effort angina (NY-HA FC I-III), 14 had depression, 19 were free of depression. Sixteen healthy volunteers comprised the control group. Platelet aggregation was registered by a mean size of aggregates and turbidometrically. Platelets shape, leukocytic-thrombocytic and erythrocytic-thrombocytic aggregates (LTA, ETA) in the whole blood were studied electron-microscopically. The levels of IL-2, IL-6, TNF-alpha, sVCAM, hsCRP were measured in the blood, serotonin--in platelets. RESULTS: Spontaneous aggregation enhanced in 52.6% CHD patients (p < 0.05). The blood contained reticular platelets, high number of prothrombocytes (p < 0.05), mean volume of thrombocytes was greater (p < 0.05). This reflected changes in megakaryocytopoiesis. Some of the patients had LTA and ETA. Out of inflammation markers, only IL-6 and sVCAM were elevated (p < 0.01), hsCRP concentration rose, but not above normal range. Serotonin in platelets was the same in the patients and controls. Depression aggravated the disorders and elevated other indices. Spontaneous aggregation was high in 71.4% of depressive CHD patients. The count of reticular platelets, prothrombocytes, mean volume platelets were also elevated. LTA and ETA were high in all the depressive patients. Elevated were also concentrations of IL-6, sVCAM, IL-2, hsCRP. Serotonin in platelets was low (p < 0.05). CONCLUSION: Depression stimulates functional activity of platelets, is a factor of risk of intravascular inflammation and contributes to development of thrombotic complications in CHD patients.

[Effect of therapy with rosuvastatin on lipid spectrum, factors of inflammation and endothelial function in patients with ischemic heart disease].

Rosuvastatin (10 mg) was given for 3 months to 30 men (mean age 57+/-9 years) with total cholesterol (CH) above 5.2 mmol/l. Questioning, physical examination, registration of ECG, measurement of levels of total, low density lipoprotein (LDL), high density lipoprotein (HDL) CH, and triglycerides (TG), assessment of endothelium-dependent brachial artery dilation were carried out at baseline and in 3 months. It was noted that 3 months therapy with rosuvastatin exerted positive effect on blood lipid spectrum: lowering of concentration of total CH (-31%, baseline 6.52+/-0.92, after therapy 4.47+/-0.96 mmol/l, p<0.0001), TG (-39%, baseline 2.73+/-1.56, after therapy 1.67+/-0.71 mmol/l, p<0.001), LDLCH (-44%, baseline 4.11+/-0.85, after therapy 2.40+/-0.90 mmol/l, p<0.0001), elevation of HDLCH (+6%, baseline 1.15+/-0.27, after therapy 1.22+/-0.34 mmol/l, p=0.08). Target LDL CH level (<2.6 mmol/l) was achieved in 23 patients (77%). Significant lowering of concentration of C-reactive protein (CRP) (-56%) and interleukin 6 (-25%) was also established. Before beginning of therapy mean flow dependent dilation was 6.1+/-1.64%, after therapy -- 10.4+/-5.0% (p<0.05). Treatment of men with ischemic heart disease with rosuvastatin (10 mg for 3 months) led to achievement of target values of LDLCH in 77% of them, to significant lowering of concentrations of CRP and interleukin 6, and to improvement of endothelial function.

[Markers of chronic inflammation in patients with ischemic heart disease with in-stent restenosis].

Concentrations of interleukins 6 and 10, tumor necrosis factor alpha, transforming growth factor beta and C-reactive protein were measured in 42 patients before and in remote period after coronary stenting. Patients with angiographically documented in-stent restenosis compared with those without restenosis had higher initial levels of interleukin 6 and more often discontinued therapy with statins.

[Assessment of myocardial viability by dobutamine stress echocardiography in patients with ischemic heart disease]. / Otsenka zhiznesposobnosti miokarda metodom stress-ékhokardiografii s dobutaminom u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Detection of viable (hibernating) myocardium is necessary for determination of prognosis and tactics of treatment of patients with ischemic heart disease. For detection of viable myocardium and investigation of possibilities of its restoration 60 patients with ischemic heart disease (54 men, mean age 52+/-8 years) were examined before coronary artery bypass grafting or coronary angioplasty. Presence of viable myocardium was characteristic for patients with multivessel coronary artery disease (83%) with stenoses >90%, with well developed collateral circulation (81%). Sustained restoration of contractility of hibernating segments for 1 year after revascularization was noted in 70% of cases. Dobutamine stress echocardiography was found to have high diagnostic potential for detection of viable myocardium.

[Flotation mass-spectra and surface potential of low density lipoprotein particles of hyperlipidemic patients after forced abolishment of lavostatin treatment]. / Flotatsionnye mass-spektry i poverkhnostnyi zariad chastits lipoproteinov nizkoi plotnosti u bol'nykh s giperlipidemiei posle vynuzhdennoi otmeny lecheniia lavostatinom.

The lipid status of lovastatin-treated hyperlipidemic patients with documented atherosclerosis of coronary arteries and carotid artery atheroma without signs of calcinosis significantly changed 4 weeks after termination of lovastatin therapy. LDL flotation mass-spectra were shown to be a sensitive indicator of variations of the lipid status. All LDL mass-spectra can be subdivided into four subfractions (from 12 to 32 S at solvent density of 1.170 g/ml and a step of 5 S). Taking into consideration previous data on total electronegative charge of LDL subfractions flotation mass-spectra indicate that lovastatin caused reduction of total negative surface charge of LDL by 1.8-fold mainly due to reduction of (17-22) and (22-27) S. However, in patients with high level of triglycerols reduction of LDL electronegative charge was due to decrease of cholesterol in (12-17) S subfraction. The latter consists of the smallest particles of the highest density. Combined analysis of similarity in lipid parameters and flotation mass-spectra of LDL allows recognizing rather homogenous groups of patients demonstrating similar responsiveness to lovastatin therapy.

[Coronary angioplasty with direct stenting: assessment of primary results and some economical aspects]. / Koronarnaia angioplastika s priamym stentirovaniem: otsenka pervichnykh rezul'tatov i nekotorykh ékonomicheskikh aspektov.

UNLABELLED: Comparison of immediate angiographical and clinical results of direct coronary stenting and stenting after predilation was carried out in 68 patients. Groups of patients subjected to direct stenting and stenting with predilation had similar clinical and angiographical characteristics. Direct stenting was successful in 100%, stenting with predilation--in 97.2% of patients with residual stenosis 5.1 and 4.9%, respectively. There were no cases of stent loss, death or emergent bypass grafting during neither the procedure nor period of hospitalization. There was 1 Q-wave myocardial infarction (2.8%) and 2 non-Q wave myocardial infarctions (1 in each group). Compared with stenting with predilation procedure of direct stenting was associated with significantly shorter procedure duration (39-/+7.1 min, 60-/+12.5 min, respectively), radiation exposure time (7.9-/+6.3 and 13.5-/+8.9 min, respectively), lower workload of the laboratory (4.9-/+3.5 and 6.1-/+2.0 patients/day, respectively), decreased consumption of contrast medium (200-/+71 and 275-/+75.9 ml, respectively), and thus lower overall cost of the procedure. CONCLUSION: Direct coronary stenting is a convenient, safe and economically justified method of stent implantation.

[Serum level of secretory phospholipase A2 (sPLA2) as a predictor of restenosis after coronary angioplasty]. / Uroven' sekretornoi fosfolipazy A2 v syvorotke krovi kak prediktor restenoza posle koronarnoi angioplastiki.

AIM: To elucidate whether secretory phospholipase A2 (sPLA2) level in the blood and catalytic activity are significant predictors of restenosis after coronary angioplasty (CAP). MATERIAL AND METHODS: Samples of venous blood were obtained from 24 patients before CAP and 1, 3, 6 days and 6 months after it. sPLA2 was measured with enzyme immunoassay, catalytic activity--using aqueous emulsion of 14C-labelled phosphatidylcholine. Control coronarography was performed in all the examinees 6 months after CAP. RESULTS: Restenosis was detected in 13 patients. In the serum of their blood sPLA2 rose significantly after CAP and persisted for 6 days after it. If restenosis was not registered, this rise was insignificant and disappeared by day 6 after CAP. Catalytic activity of sPLA2 on day 6 after CAP was significantly higher in patients who later developed restenosis. CONCLUSION: Elevated concentrations of sPLA2 in blood serum of patients after CAP may predict restenosis. Moreover, sPLA2 may not only mark inflammation but directly participate in development of restenosis.

[Occlusion of the trunk of the left coronary artery]. / Okkliuziia stvola levoi koronarnoi arterii.

Atherosclerosis-induced occlusion of the left coronary artery (LCA) is a rare findings registered angiographically. It is associated with a high risk of a fatal outcome. Eight cases of LCA occlusion are reported. A profound ST depression was shown by all ECG variants: bicycle exercise, Holter monitoring, 12-lead registration during angina attack. The conus branch gave collaterals to anterior descending artery in all the cases. Seven cases were treated surgically, one patient rejected operation and was alive at 3.5-year follow-up examination. Etiology and therapeutic policy in occlusion of the LCA are discussed.

[Anti-anginal effects of calcium antagonists and intra-cardiac hemodynamics]. / Antianginal'nyi éffekt antagonistov kal'tsiia i vnutriserdechnaia gemodinamika.

The intracardiac hemodynamics was studied in 33 patients with exertional angina pectoris undergoing an acute drug test with verapamil (n-15) and nifedipine (n-18) by using radionuclide ventriculography both at rest and during exercise. All the patients were divided into 2 groups by the increase in exercise duration with the two drugs: 1) those who exhibited a marked antianginal effect and 2) those without it. At rest, the calcium antagonists enhanced ejection fraction in the two groups. Exercise ejection fraction also increased, but in a subgroup of patients who displayed no higher exercise tolerance with verapamil. Verapamil and nifedipine in Group 1 patients resulted in lower left ventricular end diastolic volume. It is suggested that the antianginal effect of calcium antagonists is to a certain degree associated with decreased afterload, as manifested by diminished left ventricular end systolic volume.

[Evaluation of antianginal effectiveness of nicardipine in patients with angina pectoris]. / Otsenka antianginal'noi éffektivnosti nikardipina u bol'nykh so stenokardiei.

The new calcium antagonist nicardipine was studied for its potency in 73 patients with coronary heart disease concurrent with angina pectoris, including 16 with vasospastic angina. Nicardipine given in a mean daily dose of 70.1 +/- 12.4 mg induced an increase in exercise test duration by 1-2 min in 71.9% of the patients as compared with placebo. The agent was slightly less potent than nifedipine. In vasospastic angina, nicardipine was effective in 81.3% of the patients.